Resident Registration — Barangay Sto. Rosario

RESIDENT REGISTRATION FORM

Please fill out all required fields accurately

ACCOUNT INFORMATION

USERNAME *

4–20 chars, letters/numbers/underscore

PASSWORD *

Minimum 6 characters

CONFIRM PASSWORD *

PERSONAL INFORMATION

FIRST NAME *

MIDDLE NAME

SURNAME *

SUFFIX (optional)

BIRTHDATE *

Format: YYYY-MM-DD

AGE *

BIRTHPLACE *

PHOTO *

No photo

Upload

Max 2MB · JPG PNG GIF

SEX / GENDER *

Male

Female

LGBTQ+

CIVIL STATUS *

NATIONALITY

CONTACT NO.

EMAIL ADDRESS

DEMOGRAPHIC INFORMATION

RELIGION

Please type your religion

ETHNICITY / INDIGENOUS GROUP

Please type your ethnicity or indigenous group

BLOOD TYPE

PHILHEALTH (PHIC) NO.

LENGTH OF RESIDENCY (years)

PHILHEALTH MEMBERSHIP

NHTS BENEFICIARY?

Yes No

4Ps BENEFICIARY?

Yes No

HOUSEHOLD & HOUSING INFORMATION

HOUSEHOLD POSITION *

TOTAL HOUSEHOLD *

SOLO PARENT?

Yes No

Single Mother / Single Father

FAMILY PLANNING?

Yes No

HOUSE OWNERSHIP

Please describe ownership arrangement

HOUSE MATERIAL

Please describe the main material

TOILET TYPE

WATER SOURCE

Please describe your water source

ADDRESS INFORMATION

HH NO. (optional) Household Number

PUROK *

BARANGAY *

MUNICIPALITY

PROVINCE

OCCUPATION & FINANCIAL INFORMATION

OCCUPATION TYPE *

Please describe your occupation type

OCCUPATION / JOB TITLE Specific job title or position

MONTHLY INCOME (₱) Annual income auto-computed

ANNUAL INCOME (₱) Auto Monthly × 12

SOCIOECONOMIC STATUS Auto

PSA-based income classification

INCOME CLASSIFICATION GUIDE

Poor < ₱10,957/mo | Low Income ₱10,957–₱21,914 | Lower Middle ₱21,914–₱43,828
Middle ₱43,828–₱76,669 | Upper Middle ₱76,669–₱131,484 | High Income > ₱131,484

VOTER & EDUCATION

VOTER STATUS *

EDUCATIONAL ATTAINMENT

SPECIAL STATUS

PERSON WITH DISABILITY (PWD)?

No Yes

Alinsunod sa RA 7277 (Magna Carta for Disabled Persons)

IS DECEASED?

TYPE OF DISABILITY *

Klase sa Kapansanan — Pilia ang angay nga kategorya

Physical Disability Pisikal nga Kapansanan

Visual Disability Kapansanan sa Panan-aw

Hearing Disability Kapansanan sa Pandungog

Speech Disability Kapansanan sa Pagsulti

Intellectual Disability Panghunahuna nga Kapansanan

Psychosocial Disability Mental o Emosyonal nga Kapansanan

Multiple Disabilities Daghang Kapansanan

Chronic Illness Malungtarong Sakit

Other (specify below) Uban pa (ibutang sa ubos)

Specify Disability Type *

Ibutang ang klase sa kapansanan nga wala sa lista

HEALTH PROFILE

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RESIDENT REGISTRATION FORM

ACCOUNT INFORMATION

PERSONAL INFORMATION

DEMOGRAPHIC INFORMATION

HOUSEHOLD & HOUSING INFORMATION

ADDRESS INFORMATION

OCCUPATION & FINANCIAL INFORMATION

VOTER & EDUCATION

SPECIAL STATUS

HEALTH PROFILE

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